肾素瘤4例报告并文献复习  

Report of four cases of reninoma and literature review

作　　者：巫珣 王志华 WU Xun;WANG Zhihua(The Second Clinical College,Tongji Medical College of Huazhong University of Science and Technology,Wuhan 430030;Department of Urology,Tongji Hospital,Tongji Medical College of Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院第二临床学院,湖北武汉430030 [2]华中科技大学同济医学院附属同济医院泌尿外科,湖北武汉430030

出　　处：《现代泌尿外科杂志》2024年第10期880-884,922,共6页Journal of Modern Urology

摘　　要：目的探究罕见良性肿瘤肾素瘤的诊断方式、手术治疗效果及安全性,为临床诊治提供参考。方法回顾性分析华中科技大学同济医学院附属同济医院收治的4例肾素瘤患者的资料,并结合既往文献进行分析。结果除患者4表现为无症状外,其余患者均存在高血压及电解质紊乱表现。患者1合并肾上腺皮质腺瘤2次入院治疗,首次就诊未发现肾肿物,因高血压持续未降,复查时发现右肾占位;患者2初被误诊为肾癌;患者3曾因妊娠且影像学结果阴性而忽视,后因高血压持续升高并出现头晕、头痛症状,再次行影像学检查示右肾实质性肿物;患者4为无临床表现的无功能性肾素瘤。患者1先后进行了左侧肾上腺腺瘤切除术及右侧肾部分切除术,患者2~4均行肾部分切除术,所有患者术后病理结果均提示肾素瘤。患者术后血压、血钾及血浆肾素、醛固酮浓度恢复正常。除患者3术后并发休克实施抢救外,其余均恢复良好。结论肾素瘤作为罕见的良性肾脏肿瘤,进展较快,有发生高危并发症的风险,行保留肾单位术效果满意,预后较好。Objective To explore the efficacy and safety of the surgical resection and differential diagnosis of rare benign tumor,reninoma,so as to provide reference for clinical diagnosis and treatment.Methods A retrospective analysis was made on 4 patients with reninoma in Tongji Hospital,Tongji Medical College of Huazhong University of Science and Technology combined with the data of previous literatures.Results Except for patient 4,who was asymptomatic,the rest of the patients had hypertension and electrolyte imbalance.Patient 1 was admitted to hospital twice with adrenocortical adenoma.No renal mass was found on the first visit,and the right kidney abduction mass was indicated during the re-examination due to persistent hypertension.Patient 2 was misdiagnosed with kidney cancer at the beginning;patient 3 had been neglected due to pregnancy and negative imaging results,and then underwent imaging examination again to show a parenchymal mass in the right kidney due to persistent elevation of hypertension,dizziness and headache.Patient 4 had non-functioning reninoma with no clinical manifestations.Patient 1 underwent left adrenal adenoma resection and right partial nephrectomy successively,and patients 2—4 underwent partial nephrectomy.The postoperative pathological results of all patients showed reninoma.The patients blood pressure,serum potassium,plasma renin and aldosterone concentrations returned to normal after surgery.Except for patient 3,who was in shock after surgery,the rest recovered well.Conclusion Reninoma is a rare benign renal tumor with rapid progression and a high risk of complications.Nephron-sparing surgery has a satisfactory outcome and a good prognosis.

关 键 词：肾肿瘤 肾素瘤 高血压 低血钾 机器人辅助切除术 

分 类 号：R692[医药卫生—泌尿科学]